Tissue and stone removal device and related methods of use

ABSTRACT

Embodiments of a medical device and related methods of use are provided for extracting tissue. The device may include an elongate member having a proximal end and a distal end. Two or more channels may extend through the elongate member from the proximal end to the distal end, and a morcellating device may be included in one of the channels. In addition, one of the channels may be configured as a return channel for extracting the morcellated tissue.

CROSS-REFERENCE TO RELATED APPLICATIONS

This patent application claims the benefits of priority under 35 U.S.C.§§119-120 to U.S. Provisional Application No. 61/563,167, filed on Nov.23, 2011, for which the entirety is incorporated herein by reference.

FIELD OF THE INVENTION

Embodiments of the present disclosure relate generally to devicessuitable for use in medical procedures. In particular, embodiments ofthe present disclosure relate to apparatus and methods for removingtissue from within a patient's body.

BACKGROUND OF THE INVENTION

Bladder obstruction, arising from enlargement of the prostate gland inmales, is one of the most common disorders in urology. The prostategland lies under the bladder and surrounds the passageway, known as theprostatic urethra, which transfers fluids from the bladder to thesphincter and ultimately outside the body through the rest of theurethra. An enlarged prostate constricts the prostatic urethra leadingto a condition known as benign prostatic hyperplasia (“BPH”). BPH causesa variety of obstructive symptoms including urinary hesitancy, decreasedsize and force of the urinary stream, and in extreme cases, completeurinary retention, which can lead to renal failure.

To overcome these problems, the enlarged prostate may be surgicallyremoved after severing the gland from the body. One BPH treatment,referred to as enucleation of the prostate, employs an introducer, forexample, a minimally invasive device, for example, such as a cystoscope,that includes channels to insert devices, for example, an incisingdevice, a morcellating device and extraction device. The incisingdevice, which may include, e.g., a Holmium laser, may carve out theprostate lobes. The severed prostate tissues are generally large, andtherefore, a morcellating device may be used to fragment the tissue tofacilitate easier removal of the excised tissue.

Typically, morcellation of tissue is accomplished with a mechanicalmorcellator. Such mechanical morcellators are well-known in the art andmay include multiple moving parts and relatively larger diameters.Moreover, the enucleation and morcellation procedures may beaccomplished with the help of a number of other devices, such as, forexample, a visual device, an irrigation device, a resecting device. Eachof these devices is typically inserted into the body lumen through theintroducer. Accordingly, the dimensions of the inserted devices may beconstrained by the size of the cystoscope channels.

Thus, there is a need for reducing the sizes of the various tools usedin such procedures so that larger tissue fragments may be removed,thereby reducing procedure time.

SUMMARY OF THE INVENTION

Embodiments of the present disclosure provide a medical device forextracting tissue from a body.

In accordance with an aspect of the present disclosure, the medicaldevice may include an elongate member having a proximal end and a distalend. Two or more channels may extend from the proximal end to the distalend, and a morcellating device may be carried in one of the channels. Inaddition, one of the channels may be configured as a return channel,configured for extracting the morcellated tissue.

In various embodiments, the device may include one or more of thefollowing additional features: the elongate member may be flexible; theelongate member may be rigid; the morcellating device may be a laserfiber secured in the return channel; the return channel may furtherinclude a metallic tip to secure to a distal end of the return channel;the distal end of the elongate member may include a metallic tip; thetip may include a lumen having an inner diameter smaller than that of aninner diameter of the return channel; the laser fiber may be secured toan inner surface of the metallic tip with a resin that occupies aportion of an inner diameter of the tip; the return channel may beconnected to a suction device; the return channel may be tapered at thedistal end; a visualization device may be carried in one of thechannels; and a light source may be carried in one of the channels.

In accordance with another aspect of the present disclosure, anapparatus for extracting tissue may include an elongate member having aproximal end and a distal end. Two or more channels may extend from theproximal end to the distal end. The channels may include differingconfigurations. A laser fiber configured to morcellate tissue may becarried in one of the channels. A visualization device configured toobserve the tissue may be carried in another channel, and a light sourceconfigured to illuminate the tissue may be carried in one of thechannels. In addition, one of the channels may be configured as a returnchannel, configured for extracting the morcellated tissue.

In various embodiments, the apparatus may include one or more of thefollowing additional features: the return channel may be connected to asuction device for extracting morcellated tissue; the distal end of theelongate member may include a rigid tip; the laser fiber may be carriedin the return channel; the laser fiber may be secured to an innersurface of the rigid tip with a resin that occupies a portion of aninner diameter of the tip; and an irrigation system may also be carriedin one of the channels.

A further aspect of the present disclosure includes a method forextracting tissue. The method may include advancing a retrieval deviceto a location adjacent target tissue. The retrieval device may includean elongate member having a proximal end and a distal end. Two or morechannels may extend from the proximal end to the distal end. Theretrieval device may also include a morcellating device configured tomorcellate tissue. One of the channels may be configured as a returnchannel, sized for extracting the morcellated tissue. The method mayalso include illuminating the target tissue using a light sourceassociated with one of the channels, and viewing the target tissue witha visualization device. Further, the method may also includemorcellating the target tissue and extracting the morcellated tissue.

In an embodiment, the method may further include irrigating the tissueusing an irrigating system connected to the proximal end opening of oneof the channels.

Additional objects and advantages of the claimed invention will be setforth in part in the description that follows, and in part will beobvious from the description, or may be learned by practice of theinvention. The objects and advantages of the disclosure will be realizedand attained by means of the elements and combinations particularlypointed out in the appended claims.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory onlyand are not restrictive of the invention, as claimed.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the presentdisclosure and together with the description, serve to explain theprinciples of the embodiments disclosed herein.

FIG. 1 is a schematic view of a retrieval device, according to anexemplary embodiment of the present disclosure.

FIG. 2 depicts the distal end of the retrieval device according to theembodiment of FIG. 1.

FIG. 3A is a cross-sectional view of the retrieval device shown in FIG.1, taken along plane A-A.

FIG. 3B is a cross-sectional view of an alternative exemplary embodimentof the retrieval device, taken along plane A-A.

FIG. 4 illustrates exemplary embodiments of the present disclosureincluding a method of using the system to perform a surgical procedure.

DESCRIPTION OF THE EMBODIMENTS

Reference will now be made in detail to embodiments of the presentdisclosure, examples of which are illustrated in the accompanyingdrawings. Wherever possible, the same reference numbers will be usedthroughout the drawings to refer to the same or like parts.

Overview

The present disclosure relates generally to a retrieval device forremoving an undesirable mass from a body. The retrieval device mayexcise and morcellate an undesirable mass into smaller pieces,illuminate the surgical site, provide a means to view the surgical site,and extract the pieces from the body. To this end, the retrieval devicemay include an elongate tube having one or more lumens or workingchannels. It should be understood that the retrieval device may beconfigured for use with a number of medical devices to accomplish tissueremoval. For example, the retrieval device may include a visual device,an irrigation source, a light source, a morcellating device, a suctiondevice, or any other suitable device. Such devices may be integrallyformed with the retrieval device and/or one or more devices may beremovably disposed within a channel of the retrieval device or coupledto the retrieval device.

Conventionally, a tissue removal process may be performed by insertingvarious medical devices through channels of a minimally invasive devicesuch as, e.g., an endoscope, a cystoscope, or any other suitableintroduction sheath. With this implementation, the return channel towithdraw undesired mass may be constrained by the size of theintroducer's channels. As opposed to the conventional system, theretrieval device according to embodiments of the present disclosure mayemploy a single elongate tube having multiple lumens for accommodatingthe required medical devices. The size and the number of lumens may bemodified to suit the requirements. For example, the return lumen mayhave the largest cross-sectional diameter, promoting extraction oflarger tissue fragments.

Although exemplary embodiments of the present disclosure are describedwith reference to prostatectomy, it will be appreciated that aspects ofthe present disclosure have wide application. Embodiments of the presentdisclosure can be used for a variety of therapeutic procedures,including ureteroscopy, hysteroscopy, and cystoscopy, for example. Thedisclosed devices and techniques may be suitable to remove any body partor other mass. For example, the retrieval device may be utilized toremove tissue or bladder stones. Accordingly, the following descriptionsand illustrations should be considered illustrative in nature, and notlimit the scope of the claimed invention.

Exemplary Embodiments

FIG. 1 provides a schematic view of an exemplary embodiment of aretrieval device 100 for resecting an undesired mass through an incisionor a natural body opening. Retrieval device 100 may include a tube 102having a proximal end 104 and a distal end 106, and a handle 108 coupledto proximal end 104. Tube 102 may include two or more internal channels110 having proximal and distal end openings 112, 114, respectively, toreceive, e.g., one or more medical devices. The channels may be usedfor, among other things, providing irrigation, suction, and/orinsufflation. It will be understood that “proximal” and “distal”, asused in this disclosure, refer to positions or directions nearer to orfarther from the user, respectively.

Tube 102 may be advanced into a natural orifice and/or an incision at asurgical site in a patient. Tube 102 may be substantially hollow, with across-sectional configuration adapted to be received in a desired bodylumen. In the illustrated embodiment, e.g., tube 102 is generallycircular, with a generally circular hollow interior lumen. Further, thetube 102 may have a uniform diameter or may taper at its distal end 106to allow convenient insertion into the body. In another embodiment, thecross-sectional dimensions and/or configurations of tube 102 may varyalong its length, as desired. For example, a proximal portion of tube102 may include a hexagonal cross-sectional configuration while a distalportion of tube 102 may include a rectangular cross-sectionalconfiguration, based on the intended use and application. In addition,tube 102 may be transparent or translucent, allowing an operator to viewan evacuated mass within tube 102. Although tube 102 extends from handle108 in FIG. 1, tube 102 may be configured for use without handle 108during a portion or all of a surgical procedure.

Depending upon the particular implementation and intended use, thelength of tube 102 may vary. For example, the length of tube 102 may berelatively longer for procedures within longer cavities or deeperorgans, such as the bowel or intestine, or may be shorter. Similarly,depending upon the particular implementation and intended use, tube 102can be rigid along a portion of its length, flexible along a portion ofits length, or configured for flexure at only certain, specifiedlocations.

Proximal end 104 of tube 102 may be coupled to handle 108 for grippingby an operator, such as a surgeon, while distal end 106 may remain opento allow medical devices to extend out from tube 102. Handle 108 may beattached to tube 102 by any suitable means, including, for example,welding, or adhesives, or may be integrally formed with tube 102.

Tube 102 may be made of any suitable material, for example, materialsthat are compatible with living tissue or a living system. That is, tube102 may be non-toxic or non-injurious, for example, not causing animmunological reaction or rejection. Suitable materials may includenitinol, ePTFE, fabric, and suitable nickel and titanium alloys, forexample.

Tube 102 may be flexible, or adapted for flexible steering within bodilylumens, as understood in the art. In such implementations, tube 102 maybe a flexible sheath, surrounding channels 110, made of fiber or wiresthat may be woven or braided together. Suitable flexible materials mayinclude synthetic plastics, fiber, or polymers, for example. Inaddition, tube 102 may include any known additional steering mechanismto allow tube maneuver. Exemplary steering mechanisms may include pullwires connected to a distal end of tube 102 and extending up to theproximal end. For steering purposes, the pull wires may be controlled atthe proximal end either automatically or manually. Alternatively, tube102 may be rigid or semi-rigid and may be made of any suitablematerials, e.g., stainless steel or shape memory alloys such as nitinol.

To impart stability to flexible tube 102, distal end 106 may beconnected to a rigid, hollow tip. FIG. 2 illustrates an embodiment ofdistal end 106 of tube 102. As shown, distal end 106 may be connected toa rigid tip 202, which may be generally cylindrical and made of a rigidmaterial, such as stainless steel. Tip 202 may be a generally circular,hollow structure having a diameter substantially similar to that of tube102. In one embodiment, tip 202 may include a diameter smaller than thatof tube 102, so that tip 202 may be received within tube 102. In oneembodiment, tip 202 may include a larger diameter so that the distal endof tube 102 may be received in tip 202. In some embodiments, tip 202 andtube 102 may be dimensioned so that the two device are secured to eachother. Further, tip 202 may taper towards a narrower distal end opening,allowing only a particular-sized mass to enter tube 102. In addition,distal end 204 of tip 202 may be cut on a slant or an angle, other thanperpendicular, to the longitudinal axis of tube 102. The illustratedembodiment depicts this slant distal end 204 in a side view of tip 202.

Tip 202 may be connected to tube 102 by any known securing mechanism,such as, e.g., glue or sealant. Additionally, the outer surface of tip202 and inner surface of tube 102 may include projections, grooves,screws, or similar members that provide a snap-fit attachment betweenthe two devices. In an alternate embodiment, tip 202 may be integrallyformed with tube 102.

Tube 102 and tip 202 may be designed to impose minimum risk to thesurrounding tissues while in use. To this end, proximal end 104, distalend 106, and/or tip edges may include geometrical structures, such asrounded or beveled terminal ends and/or faces, to reduce trauma andirritation to surrounding tissues. Further, the outer surface of tube102, including tip 202, may include any suitable coating and/orcovering, such as a layer of lubricous material, to facilitate insertioninto a body lumen or surgical insertion.

In addition, one or more portions of tube 102 may include radiopaque orsonoreflective markings. That result can be accomplished by any ofsuitable conventional techniques, such as, e.g., inclusion of bariumsulfate in plastic material or inclusion of one or more metal portions.These markings can be added to the exterior surface of tube 102 todetect the position and orientation of retrieval device 100 within thepatient's body. A surgeon, with the aid of suitable imaging equipment,may view these markings to enable optimal positioning of retrievaldevice 100 to avoid potential damage to sensitive tissues.

The outer surface of tube 102 may also include geometrical structures(not shown) that may act as anchoring mechanisms. These geometricalstructures may include hooks, barbs, or spikes that may assist inengaging tube 102 with the surrounding tissues, once deployed. Thegeometrical structures may be deployed at distal end 106, or they may bepositioned along the length of tube 102.

In an alternative embodiment, tube 102 may be made of a self-expandableor compressible device that changes state during use. For example, tube102 may be compressed to reduce its overall diameter, allowing insertioninto relatively smaller body lumens, such as those in a patient'surethra. In the expanded configuration, tube 102 may expand in a radialdirection. The expanded state may allow inclusion of multiple medicaldevices. Expansion and/or compression of tube 102 may be achieved byincorporating one or more expansion mechanisms, e.g., springs, baskets,or coil structures, within tube 102. In an embodiment, tube 102 may bemade of shape memory material, such as Nitinol, that changes state uponexposure to a trigger.

Tube 102 may be adapted to receive multiple medical devices. To thisend, proximal end 104 of tube 102 may include multiple ports 116 a, 116b, 116 c, 116 d, and 116 e, collectively referred to as ports 116. Eachof ports 116 may connect to an internal channel, and a device advancinginto port 116 may extend from distal end 106 of tube 102 via theconnected channel. “Port” may refer to the proximal end opening ofchannel 110, or it may be an additional opening attaching the tube'sproximal end 104 to channel's proximal end opening 112. Alternatively,proximal end 104 of tube 102 may be open to insert devices into channels110 directly.

In general, the number of ports 116 may correspond to the number ofchannels 110 within tube 102. Alternatively, the number of ports 116 maybe greater or less than the number of channels 110.

Tube 102 may include multiple channels 110 to slidingly receive two ormore devices, either independently or simultaneously. Each channel maybe configured to slidingly receive at least one medical device throughthe corresponding port 116. In general, channels 110 may be hollow,elongate structures extending from proximal end 104 to distal end 106.The following section describes these channels in greater detail.

In an alternate embodiment, tube 102 may itself receive incoming medicaldevices to perform the required procedures, including, for example alaser fiber to morcellate a tissue. These devices may be held in placeby attaching them to tip 202 or the inner surface of tube 102, forexample. In this embodiment, the fiber may be introduced through tube102 and may be connected to tip 202 using a resin.

FIGS. 3A and 3B illustrate a cross-sectional view of an alternativeembodiment of tube 102 (taken along plane A-A′ in FIG. 1) depictingmultiple channels. As shown in FIG. 3A, tube 102 may includeillumination channels 302 a, visualization channel 302 b, workingchannels 302 c, and return channel 302 (collectively referred to aschannels 302). It should be understood that channels 302 may be similarto channels 110, shown in FIG. 1; for description purposes, however,these channels are discussed with specific names.

As shown in FIG. 3A, illumination channels 302 a may be connected to alight source 304; visualization channel 302 b may accommodate avisualization device 306; return channel 302 d may induce a suctionforce using a suction device 308; and the working channel mayaccommodate a morcellating device 310, an irrigation system 312, or anyother suitable devices, depending on the surgical procedure. As shown,tube 102 may include well-defined channels for various devices and mayinclude a return channel 302 d to evacuate excised tissue masses. Theillustrated embodiment depicts devices required to performprostatectomy, for example. It should be understood that the medicaldevices inserted into channels 302 may vary based on the surgicalprocedure performed by retrieval device 100.

In general, channels 302 may be defined as elongate hollow lumens thatextend, at least partially, between proximal end 104 and distal end 106of tube 102. Each channel may allow at least one elongate medical deviceto extend from proximal end 104 to distal end 106, and thus, thediameter of channel 302 may vary accordingly. As shown, return channel302 d may be the largest channel, allowing convenient evacuation of amass.

The number of channels and their configuration may vary depending on theintended use of the system and the tools required during a procedure.While six channels are illustrated in FIG. 3A, for example, fewerchannels or more channels are also contemplated. For example, tube 102may include a single channel configured to extract a mass from a body,and the channel may also be adapted to receive multiple tools.

Further, channels 302 may have any suitable cross-sectionalconfiguration. For example, as shown, each of channels 302 a and 302 cmay have a substantially circular cross-sectional configuration, whilechannel 302 b may have a square cross-sectional configuration. Moreover,return channel 302 d may have a semi-circular configuration. In someembodiments, however, one or more of channels 302 may have across-sectional configuration that corresponds to a configuration of aparticular tool. In this manner, a particular channel may bespecifically designed and dedicated for use with a particular tool.

In addition, although the depicted embodiments illustrate that channels302 include substantially uniform cross-sectional configurations anddimensions, the cross-sectional dimensions and/or configurations of anyof channels 302 may vary as desired. For example, a proximal portion ofchannel 302 may include a hexagonal cross-sectional configuration, whilea distal portion of channel 302 may include a rectangularcross-sectional configuration. In another embodiment, return channel 302d may taper towards a narrower distal end opening. Such tapering mayallow only a particular sized mass to enter return channel 302 d,reducing clogging of extracted mass within the channel.

Channels 302 may be flexible, semi-rigid, or rigid. Rigidity of channels302 may generally depend on that of tube 102. In one embodiment, tube102 may be rigid; however, internal channels 302 may be flexible toaccommodate incoming devices. That is, any of channels 302 may beselectively expanded with the insertion of a medical device larger thanthe channel. Further, one or more channels 302 may include opticalfibers. Alternatively, channels 302 may be made of any suitablematerial, such as, e.g. rubber, fiber, stainless steel. Channels 302 mayinclude sealing mechanisms, such as seals or gaskets, for example, thatmay enable an incoming medical device to fit into the channel. Inaddition, an inner surface of any of channels 302 may also include alubricous coating that allows passage of incoming devices such as, e.g.,a camera.

Visualization device 306 may advance into, e.g., visualization channel302 b, via visualization port 116 a and may extend out from a distal endopening of channel 302 b. In addition, a visual interface 314 may beconnected proximate visualization port 116 a for viewing the surgicalsite during the procedure. In an embodiment, the visualization device306 may be an elongated camera, and a display screen at proximal end 104may present the images captured by the camera. In such implementations,a miniature camera, e.g., as small as 1 mm by 1 mm, may be used. Inaddition, substantially high-resolution cameras may be employed tocapture a view of the surgical site. Alternatively, visualization device306 may include a telescope having an eyepiece at its proximal end toview the surgical site.

In general, visualization devices may require illumination to capturethe target area. Light source 304 connected to illumination port 116 bmay illuminate the distal portion of tube 102 through illuminationchannel(s) 302 a. In one embodiment, an optical fiber may be advancedinto illumination channel 302 a, allowing light to pass through.Alternatively, illumination channel 302 a may itself be an optical fiberdirectly connected to light source 304.

Morcellating device 310 may be used to fragment a mass when insertedinto working channel 302 c via working channel port 116 c. This devicemay extend along the length of working channel 302 c and outward fromdistal end 106. In one embodiment, the morcellating device may alsoperform the step of enucleating the undesired mass from the body part.

A laser system may act as morcellator 310. The laser system may directlaser energy through the working channel, and this energy may bedirected outward from distal end 106 longitudinally or laterally, asdesired. The laser may not only separate the mass from the body, but itmay also break the mass down into smaller pieces. The laser device maybe positioned at the proximal end of an optical fiber extending throughworking channel 302 c. Alternatively, the channel may itself be anoptical fiber that allows passage of laser beams. A laser system mayutilize a laser fiber operating at a wavelength ranging fromapproximately 200 to approximately 500 microns, for example, accordingto the desired purpose. Various laser systems may include holmiumlasers, erbium lasers, KTP, Thulium, or Nd:Yag lasers. In oneembodiment, holmium lasers may have a high peak pulse.

Alternatively, morcellating device 310 may be any known tissue or masscutting device, such as a cautery device or a blade, for example. Thoseskilled in the art will understand that any device suitable formorcellating tissue may be used in accordance with the presentdisclosure.

In addition, suction device 308 may withdraw the morcellated mass fromthe body through, e.g., return port 116 e via return channel 302 d. Asshown, return channel 302 d may be the largest channel of tube 102,allowing minimum blockage of retrieved mass while extraction. As alreadydiscussed, channels 302 d of tube 102 may be designed such that returnchannel 302 d is suitable to extract large pieces of a mass from a body.For extraction, the distal end of return channel 302 d may be connectedto suction device 308, which may be a vacuum source such as a mechanicalpump, for example. In addition, suction device 308 may be connected to atrap 316, which may be a container or a bag, to collect mass and fluidsaspirated from the patient. Furthermore, suction device 308 may also beconnected to a control that regulates the suction force induced,restricting the force with which the morcellated mass is extracted.Suction device 308 may induce a suitable amount of force so as to avoidharming other body parts. In an alternate embodiment, mechanicalstructures, such as a grasper or clamp, e.g., that can grasp themorcellated mass may also be inserted into the working channel toretrieve morcellated masses.

Suction device 308 may be employed in connection with irrigation system130. Working port 116 c, connected to one of working channel 302 c, mayallow a fluid to be directed towards the surgical site through thechannel. Irrigation may be used to clean the surgical site during thesurgical procedure. In addition, irrigation may maintain a cleanenvironment for the procedure and a clear field of view for the surgeon.For this purpose, a suitable fluid, such as saline water, may beemployed. The suction device may aspirate the morcellated mass alongwith the irrigation fluid.

In addition to the devices discussed above, various other devices mayalso be introduced depending on the desired procedure. In oneembodiment, various biopsy devices, baskets, or other suitableinstruments, may also be introduced.

As shown, embodiments of the present disclosure may facilitate anall-in-one retrieval device 100 that not only retrieves an undesiredmass from a body, but may also morcellate the mass, illuminate andirrigate the surgical site, and provide images of the surgical site.Device 100 may include a single tube having a wide return channel andone or more additional channels for inserting other medical devices toaccomplish additional functionalities. FIG. 3A shows one such embodimentof tube 102 having channels 302 to facilitate this purpose. Those in theart will understand that a range of alternatives could be highlighted tosupport alternate implementations of the retrieval device 100. Forexample, morcellator device 310 may not pass through working channel 302c; instead, it may be inserted into return channel 302 d. Theillumination may be provided by a single channel as opposed to the twochannels, as depicted in FIG. 3A.

FIG. 3B illustrates a cross-sectional view of an alternative embodimentof tube 102, taken along line A-A in FIG. 1. Some of the channelsdepicted in FIG. 3B may be similar to the embodiment shown in FIG. 3A,such as illumination channels 302 a, visualization channel 302 b, andworking channel 302 c. These elements may operate in a similar fashionand thus require no further elaboration. In addition, the illustratedembodiment may include a laser fiber 302 e introduced into returnchannel 302 d for morcellating purposes. As shown, laser fiber 302 e maybe securely affixed to a surface of channel 302 d.

Laser fiber 302 e, directing a laser beam towards the mass, may not onlymorcellate the mass, but may also assist in enucleating the mass fromthe body prior to morcellation. As laser fiber 302 e is inserted intoreturn channel 302 d, working channel 302 c may be utilized to introduceother desired devices within the body. Alternatively, one of the workingchannels may be removed to increase the cross-sectional area of returnchannel 302 d.

In one embodiment, channels 302 may be coupled to metallic tip 202,shown in FIG. 2, of tube 102 using known securing mechanisms. In oneembodiment, UV-cured material or resin, e.g., may be deposited along theinner surface of channel 302 within tube 102 to secure tip 202 therein.In such implementations, a significant amount of resin material may bedeposited around laser fiber 302 e to narrow the distal end opening ofchannel 302 d. Narrowing the opening may allow only tissue piecessmaller than the diameter of return channel 302 d to enter tube 102,decreasing the opportunity for those pieces to clog tube 102.

Various alternatives to narrow the distal end opening of return channel302 d may be contemplated. In one embodiment, return channel 302 d mayitself taper at its distal end. Alternatively, a selectively expandablemember, such as a balloon, e.g., may be coupled to the distal innercircumference of return channel 302 d. This expandable member may reducethe size of the distal end opening of return channel 302 once tube 102is deployed at the desired location. In another embodiment, a distalinner surface of return channel 302 d may include projections orprotrusions that decrease the size of the opening. Further, a mesh-likestructure having a desired cell size may be connected to the distal endopening of return channel 302 d, allowing a mass smaller than the cellsize to enter tube 102. In some embodiments, the distal end opening ofreturn channel 302 may be selectively controllable by a user using aknown control mechanism. In such embodiments, the control mechanism mayprovide suitable feedback to inform the user of the distal end opening'ssize, and subsequently, the size may be modified, as desired.

In an alternate embodiment, tube 102, along with the channel 302, may bemade of resilient materials that expand when a device is inserted intothem. For example, visualization channel 302 b could expand to fitsnuggly around the elongate camera, thereby providing a seal against theingress of body fluids and materials. In addition, channels 302 mayexpand, once deployed, permitting entry of large-sized devices.

In another embodiment, channels 302 and/or tube 102 may be made ofdiscrete sections movably linked to one another. Each section may moverelative to the adjacent sections, imparting flexibility to channels302. Discrete sections may be made of a variety of materials, including,for example, a metal, a non-metal, or a shape memory metal, such asnitinol.

FIG. 4 illustrates a method of using retrieval device 100 according toan embodiment of the present disclosure. The following section describesthe implementation of retrieval device 100 in prostatectomy, a procedureto remove prostate 402 from the urinary system. Further, the embodimentof the present disclosure may employ a laser system, such as morcellatordevice 310. It should be apparent that embodiments of this method may beapplicable to a variety of surgical procedures, and a number of themedical devices alluded to above may be employed for resecting theundesired mass.

As tube 102 includes multiple channels to insert the required medicaldevices, retrieval device 100 may be operated without utilizing anintroducer device, such as an endoscope of a cystoscope. Those skilledin the art will understand that the size and configuration of theintroducer's working channels may limit the cross-sectional diameter ofa return channel for extracting the morcellated prostate from the body.Here, because retrieval device 100 is an all-in-one device, a widerpassage may be available for return channel 302 d.

As shown, proximal end 104 of tube 102 may be connected to variousdevices to perform prostatectomy using ports 116. Visualization port 116a may be connected to visualization device 306 such as, e.g., a camera,and illumination port 116 b may be connected to light source 304.Working ports 116 c and 116 d may be connected to a laser system 310 andan irrigation system 312, respectively. In addition, return port 116 emay be attached to suction device 308. As already discussed, lasersystem 310 may introduce laser fiber 302 e either into a channel, suchas working channel 302 c, or may be inserted into return channel 302 d.

Under a method of the present disclosure, retrieval device 100 may beinserted into the patient's body. For insertion purposes, distal end 106of tube 102 may include an atraumatic, rigid, leading edge that may beinserted percutaneously into the urinary system. Alternatively, aslanted tip 202 may allow percutaneous insertion of tube 102. In someembodiments, tube 102 may be introduced via a catheter or with the aidof guide wires or any suitable device that may allow insertion of tube102.

Tube 102 may be inserted into the body of a patient until distal end 106is adjacent prostate 402. Distal end 106 of tube 102 may be manipulatedto advance towards the surgical location or for repositioning. In oneembodiment, the flexible characteristics of tube 102 may allow formaneuvering along the body lumens. Alternatively, an externalmanipulation mechanism may guide tube 102 towards a target site. Forexample, distal portion of tube 102 may be connected to pull wires,which may extend up to proximal end 104 for manipulation. Pull wires maybe retracted to deflect distal end 106 left or right and/or upward ordownward. Pull wires may be controlled manually by a clinician, or anelectronic controller may operate the wires. In one embodiment, multiplepull wires may be attached to tube 102 to deflect tube 102 in multipledirections at multiple points along its length. Appropriate positioningof tube 102 may also be accomplished using visualization device 306inserted into visualization channel 302 b.

Once distal end 106 of tube 102 reaches close to prostate 402, themedical devices, such as, e.g., a laser system, a suction source, anirrigation source, etc, may be advanced through one or more channels302.

To begin a prostatectomy, a laser system may be activated and thetargeted prostate tissues may be incised using laser energy. Thetargeted prostatic tissue may be incised and separated from the bodyeither in its entirety, or in pieces. It may be preferable to incise thetargeted prostatic tissue in its entirety to minimize the number ofincisions made during the procedure. The surgeon may continue viewingthe surgical location using the visualization device. Further, thedistal end of tube 102 may be maneuvered along the prostate walls duringthis process. Irrigation system 130 may be activated to clear thesurgical site.

The excised pieces of prostatic tissue may then be pushed into thebladder either by the irrigation fluid exiting the working channel 302c, or by manually pushing the tissue with a distal end of tube 102.Alternatively, suction device 308, attached to retrieval device 100, mayhold the prostate pieces close to distal end 106 and retrieval device100 may then advance into the bladder to deposit the prostate pieces.The bladder may provide a relatively large space for morcellation of theprostate tissues, and may reduce the risk of damaging adjacent tissue.The surgeon may then reposition the distal end of tube 102 toward thecenter of the bladder, where it may be safe to break down prostatetissues. Alternatively, retrieval device 100 may not reposition theprostate gland tissue to the bladder and these tissues may bemorcellated and extracted from their current location.

Next, laser fiber 302 e may direct optical energy to fragment prostatetissues into smaller pieces. It should be understood that any suitablemorcellating device may replace laser fiber 302 e without departing fromthe scope of the present disclosure. Simultaneously, irrigation system312 and suction device 308 may be activated to provide irrigation andaspiration (suction) at the distal end. The reciprocating action ofirrigating the surgical site together with the aspiration from suctiondevice 308 may efficiently resect the targeted prostatic tissue (cutinto smaller pieces by laser system) from the patient. Prostate tissuepieces smaller than the cross-sectional size of return channel 302 d maybe withdrawn through channel 302 d. In one embodiment, return channel302 d may taper along the distal end to reduce coagulation of tissueswithin the channel. Once tissue is fully aspirated out of the patient,the medical devices may be deactivated, and tube 102 may be pulled outof the body.

This description contemplates a primarily manual operation of thedisclosed method. As known in the art, a number of automation techniquesmay be applied, for example, to improve control and accuracy of theprocess. For example, the exact amount and intensity of laser may bemonitored by a control mechanism, or the penetration itself may becarried out under computer control.

The present disclosure discloses a system that allows resection ofmasses from a patient's body through natural orifices or incisions. Thesystem may employ a tube having channels that facilitate morcellationalong with resection, visualization, irrigation and any additionalcapabilities.

Other embodiments of the disclosure will be apparent to those skilled inthe art from consideration of the specification and practice of theembodiments disclosed herein. It is intended that the specification andexamples be considered as exemplary only, with the true scope and spiritof the invention being indicated by the following claims.

What is claimed is:
 1. A medical device for extracting tissue, thedevice comprising: an elongate member having a proximal end and a distalend; two or more channels extending through the elongate member from theproximal end to the distal end; and a morcellating device configured tomorcellate tissue, carried in one of the channels; wherein one of thechannels is configured as a return channel, configured for extractingmorcellated tissue.
 2. The device of claim 1, wherein the elongatemember is flexible.
 3. The device of claim 1, wherein the elongatemember is rigid.
 4. The device of claim 1, wherein the morcellatingdevice is a laser fiber secured in the return channel.
 5. The device ofclaim 4, wherein the return channel further includes a metallic tipsecured to a distal end of the return channel.
 6. The device of claim 1,wherein the distal end of the elongate member includes a metallic tip.7. The device of claim 6, wherein the tip includes a lumen having aninner diameter smaller than that of an inner diameter of the returnchannel.
 8. The device of claim 5, wherein the laser fiber is secured toan inner surface of the metallic tip with a resin that occupies aportion of an inner diameter of the tip.
 9. The device of claim 1,wherein the return channel is operably coupled to a suction device. 10.The device of claim 1, wherein the return channel is tapered at thedistal end.
 11. The device of claim 1, further including a visualizationdevice in one of the channels.
 12. The device of claim 1, furtherincluding a light source carried in one of the channels.
 13. Anapparatus for extracting tissue, the apparatus comprising: an elongatemember having a proximal end and a distal end; two or more channelsextending through the elongate member from the proximal end to thedistal end, wherein the channels include differing configurations; alaser fiber configured to morcellate tissue in one of the channels; avisualization device configured to observe the tissue in one of thechannels different than the channel including the laser fiber; and alight source configured to illuminate tissue, carried in one of thechannels different than the channel carrying the laser fiber; whereinone of the channels is configured as a return channel and is configuredfor extracting morcellated tissue.
 14. The apparatus of claim 13,wherein the return channel is operably coupled to a suction device forextracting morcellated tissue.
 15. The apparatus of claim 13, whereinthe distal end of the elongate member includes a rigid tip.
 16. Theapparatus of claim 13, wherein the laser fiber is included in the returnchannel.
 17. The apparatus of claim 15, wherein the laser fiber issecured to an inner surface of the rigid tip with a resin that occupiesa portion of an inner diameter of the tip.
 18. The apparatus of claim13, further comprising an irrigation system carried in one of thechannels.
 19. A method for extracting tissue, the method comprising:advancing a retrieval device to a location adjacent a target tissue,wherein the retrieval device comprises: an elongate member having aproximal end and a distal end; two or more channels extending throughthe elongate member from the proximal end to the distal end; and amorcellating device configured to morcellate tissue; wherein one of thechannels is configured as a return channel for extracting morcellatedtissue; illuminating the target tissue using a light source associatedwith one of the channels; viewing the target tissue with a visualizationdevice; morcellating the target tissue; and extracting the morcellatedtissue.
 20. The method of claim 19, further comprising severing thetarget tissue from an in situ location.